The symposium began with an introduction by Benjamin Greenberg, MD, MHS, Assistant Professor in the Department of Neurology and Neurotherapeutics and the Department of Pediatrics. Dr. Greenberg is also the Director of the Transverse Myelitis and Neuromyelitis Optica Program, Director of the Pediatric Demyelinating Disease Program, and Deputy Director of the Multiple Sclerosis Program. The goal of Dr. Greenberg’s presentation was to provide a basic understanding of the nervous system and immune system and the relationship between these two systems in an autoimmune, demyelinating disease. Beginning on the seventh slide, Dr. Greenberg introduces an analogy of a stereo system to explain the effects of damage to the wires (neurons) in the nervous system. Wires of a stereo system contain an insulating material that enables them conduct the electricity effectively. Similarly, neurons have a coating called the myelin sheath that accomplishes the same goal. If a wire is cut or the insulation around the wire is damaged in the stereo system, the signals will not be sent to the speakers properly and the stereo system will not work correctly. Similarly, if the wires of the nervous system are damaged, the signals that they transmit will not be sent correctly. To explain an autoimmune, demyelinating disease, Dr. Greenberg expanded on the stereo model by comparing the immune system to a house cat. A house cat has been raised to hunt mice, which represent foreign invaders in your body. The immune system’s response to foreign invaders is what keeps one healthy and well. However, sometimes the cat will chew on things in the house that are not mice and this can be destructive to personal belongings. This represents autoimmune diseases in which the immune system will attack things within thie body that are important and are not foreign invaders. For autoimmune, demyelinating diseases, the immune system views the myelin sheath on the neurons in the central nervous system as foreign invaders and causes demyelination, destruction of the myelin sheath. To refer back to the analogy of a cat and the stereo system, this would be analogous to the cat chewing on the wires of the stereo system. The goal of research focused on these diseases is to determine which cat is chewing on the wires of the stereo system and how to stop this action to eliminate further damage.
Dr. Greenberg provided an overview of the rare neuro-immunologic disorders in this spectrum and described which “wires” are being affected in which disease and the incidence of relapse in each of these diseases. He also detailed the advancements that have been made in the understanding of NMO through the findings of the NMO IgG, an antibody specific to patients diagnosed with NMO.
Dr. Greenberg finished his introduction by providing a brief description of the necessity of repository-style research projects in the research of these diseases. He mentioned Donald Rumsfeld’s quote to highlight the “unknown unknowns”, or the things that researchers don’t know to investigate yet. However, the repository-style research projects will allow researchers access to large amounts of samples and data in the case that future researchers discover that they need to research something that has not been investigated previously. For instance, Dr. Greenberg described that right now when drawing blood, the red-top tubes are of most interest to him. However, as research progresses, he may find that the yellow-top tubes are what we should be looking at. At this point he will be able to go back to the repository and will have a large amount of these yellow-top tubes that he can use in his research. As researchers are furiously searching for the causes of NMO and TM, the biorepositories allow them to look into various aspects of the disease to search for a better understanding of these diseases to better treat and hopefully cure these conditions.